Adapting response to a measles outbreak in a context of high vaccination and breakthrough cases: an example from Vaud, Switzerland, January to March 2024.

A measles outbreak with 51 cases occurred in the canton of Vaud, Switzerland, between January and March 2024. The outbreak was triggered by an imported case, and 37 (72.5%) subsequent cases were previously vaccinated individuals. Epidemiological investigations showed that vaccinated measles cases were symptomatic and infectious. In a highly vaccinated population, it is important to raise awareness among healthcare professionals to suspect and test for measles virus when an outbreak is declared, irrespective of the vaccination status of the patients.

Seizures in Children with Influenza during the 2022-2023 Winter Season, a Case Series.

Influenza is a viral infection presenting with general symptoms such as fever, headache, fatigue, and involvement of airways or the gastrointestinal tract. The nervous system may be involved, but less frequently. These neurological complications remain challenging to diagnose; moreover, no guidelines for management and treatment exist. Therefore, when presenting with neurological symptoms, patients undergo invasive diagnostic procedures and empirical treatments before making the correct diagnosis. During the winter of 2022-2023, four children between nine months and nine years of age were admitted to the Lausanne University Hospital, Switzerland, complaining of influenza and neurological complications. This report presents the symptoms of neurological manifestation and the treatment management of the four patients. All the legally authorized representatives gave their written informed consent before study inclusion.

Viral suppression and retention in HIV care during the postpartum period among women living with HIV: a longitudinal multicenter cohort study.

Background: Low rates of postnatal retention in HIV care and viral suppression have been reported in women living with HIV (WLWH) despite viral suppression at delivery. At the same time, postpartum follow-up is of crucial importance in light of the increasing support offered in many resource-rich countries including Switzerland to WLWH choosing to breastfeed their infant, if optimal scenario criteria are met. Methods: We longitudinally investigated retention in HIV care, viral suppression, and infant follow-up in a prospective multicentre HIV cohort study of WLWH in the optimal scenario who had a live birth between January 2000 and December 2018. Risk factors for adverse outcomes in the first year postpartum were assessed using logistic and proportional hazard models. Findings: Overall, WLWH were retained in HIV care for at least six months after 94.2% of the deliveries (694/737). Late start of combination antiretroviral therapy (cART) during the third trimester was found to be the main risk factor for failure of retention in HIV care (crude odds ratio [OR] 3.91; 95% confidence interval [CI], 1.50-10.22; p = 0.005). Among mothers on cART until at least one year after delivery, 4.4% (26/591) experienced viral failure, with illicit drugs use being the most important risk factor (hazard ratio [HR], 13.2; 95% CI, 2.35-73.6; p = 0.003). The main risk factors for not following the recommendations regarding infant follow-up was maternal depression (OR, 3.52; 95% CI, 1.18-10.52; p = 0.024). Interpretation: Although the results are reassuring, several modifiable risk factors for adverse postpartum outcome, such as late treatment initiation and depression, were identified. These factors should be addressed in HIV care of all WLWH, especially those opting to breastfeed in resource-rich countries. Funding: This study has been financed within the framework of the Swiss HIV Cohort Study, supported by the Swiss National Science Foundation (grant #201369), by SHCS project 850 and by the SHCS research foundation.

Successful implementation of new Swiss recommendations on breastfeeding of infants born to women living with HIV.

INTRODUCTION: Swiss national recommendations advise, since end of 2018, supporting women with HIV who wish to breastfeed. Our objective is to describe the motivational factors and the outcome of these women and of their infants. METHODS: mothers included in MoCHiV with a delivery between January 2019 and February 2021 who fulfilled the criteria of the "optimal scenario" (adherence to cART, regular clinical care, and suppressed HIV plasma viral load (pVL) of <50 RNA copies/ml) and who decided to breastfeed after a shared decision-making process, were approached to participate in this nested study and asked to fill-in a questionnaire exploring the main motivating factors for breastfeeding. RESULTS: Between January 9, 2019 and February 7, 2021, 41 women gave birth, and 25 decided to breastfeed of which 20 accepted to participate in the nested study. The three main motivational factors of these women were bonding, neonatal and maternal health benefits. They breastfed for a median duration of 6.3 months (range 0.7-25.7, IQR 2.5-11.1). None of the breastfed neonates received HIV post-exposure prophylaxis. There was no HIV transmission: 24 infants tested negative for HIV at least 3 months after weaning; one mother was still breastfeeding when we analyzed the data. CONCLUSIONS: As a result of a shared decision-making process, a high proportion of mothers expressed a desire to breastfeed. No breastfed infant acquired HIV. The surveillance of breastfeeding mother-infant pairs in high resource settings should be continued to help update guidelines and recommendations.

School-based HPV Vaccination: Variation in Inter-school Vaccine Uptake not Influenced by the Introduction of a New Information Brochure.

BACKGROUND: Switzerland, with an adolescent HPV vaccination coverage at 59%, remains far from reaching the crucial swiss national goal of 80% coverage. Our objective was to implement a new information brochure in schools to increase HPV vaccination uptake. METHODS: We designed a public health quality project. A new information brochure was produced and was distributed to a test group of 9th grade students from the Canton of Vaud, in Switzerland during the 2019-2020 school year. Vaccine uptake of the test group was compared to those of all other students in 2019-2020 and of students in the same schools in 2017-2018. RESULTS: 12,143 electronic records were analyzed. 713 students were enrolled in 6 schools where the new brochure was distributed. Median age was 13 years (IQR 12-13), and 6,031 (49.7%) were female. Vaccine uptake was 52% (6,299/12,143). The new brochure did not result in increased uptake. Age ≥ 13 years (aOR 1.39, 95% CI 1.22-1.58) was significantly associated with uptake. Uptake increased between 2017-2018 (51%, 3,216/6,307) and 2019-2020 (52.8%, 3,083/5,836, p=0.04) due to increased acceptance among boys. The only determinant of uptake in 2019-2020 was uptake in the same schools in 2017-2018. CONCLUSION: The introduction of a new information brochure was insufficient to increase HPV vaccination coverage. More innovative strategies are needed.

Swiss Evaluation Registry for Pediatric Infective Endocarditis (SERPIE) - Risk factors for complications in children and adolescents with infective endocarditis.

BACKGROUND: Infective endocarditis (IE) in pediatric patients is a severe cardiac disease and its actual epidemiology and clinical outcome in Switzerland is scarcely studied. METHODS: Retrospective nationwide multicenter data analysis of pediatric IE in children (<18 years) between 2011 and 2020. RESULTS: 69 patients were treated for definite (40/69;58%) or possible IE (29/69;42%). 61% (42/69) were male. Diagnosis was made at median 6.4 years (IQR 0.8-12.6) of age with 19 patients (28%) during the first year of life. 84% (58/69) had congenital heart defects. IE was located on pulmonary (25/69;35%), mitral (10/69;14%), tricuspid (8/69;12%) and aortic valve (6/69;9%), and rarely on ventricular septal defect (VSD;4/69;6%) and atrial septal defect (ASD;1/69;1%). In 22% (16/69) localization was unknown. 70% (48/69) had postoperative IE, with prosthetic material involved in 60% (29/48; right ventricular to pulmonary artery conduit (24), VSD (4), ASD (1)). Causative organisms were mostly Staphylococci spp. (25;36%) including Staphylococcus aureus (19;28%), and Streptococci spp. (13;19%). 51% (35/69) suffered from severe complications including congestive heart failure (16;23%), sepsis (17;25%) and embolism (19;28%). Staphylococcus aureus was found as a predictor of severe complications in univariate and multivariate analysis (p = 0.02 and p = 0.033). In 46% (32/69) cardiac surgery was performed. 7% (5/69) died. CONCLUSIONS: IE in childhood remains a severe cardiac disease with relevant mortality. The high morbidity and high rate of complications is associated with Staphylococcus aureus infections. Congenital heart defects act as a risk factor for IE, in particular the high number of cases associated with prosthetic pulmonary valve needs further evaluation and therapeutic alternatives.

Swiss recommendations on perioperative antimicrobial prophylaxis in children.

Infection following surgical procedures leads to significant morbidity and mortality in all age groups. Sterile techniques, antibiotic prophylaxis and improved postoperative wound care have contributed to the decline of surgical site infections since the early days of surgery. Recommendations on the use of perioperative antimicrobial prophylaxis exist for adults, but are rare for the paediatric population. Here, we provide a standardised approach to the effective use of antimicrobial agents for the prevention of surgical site infections in children contributing to a targeted and rational perioperative use of antibiotics in Switzerland.

Transfer of antiretroviral drugs into breastmilk: a prospective study from the Swiss Mother and Child HIV Cohort Study.

INTRODUCTION: In 2018, Switzerland changed its guidelines to support women living with HIV wishing to breastfeed. The exposure of antiretroviral drugs (ARVs) in breastmilk and the ingested daily dose by the breastfed infant are understudied, notably for newer ARVs. This study aimed to quantify ARV concentrations in maternal plasma and breastmilk to determine the milk/plasma ratio, to estimate daily infant ARV dose from breastfeeding and to measure ARV concentrations in infants. METHODS: All women wishing to breastfeed were included, regardless of their ARV treatment. Breastmilk and maternal plasma samples were mostly collected at mid-dosing interval. RESULTS: Twenty-one mother/child pairs were enrolled; of those several were on newer ARVs including 10 raltegravir, 1 bictegravir, 2 rilpivirine, 2 darunavir/ritonavir and 3 tenofovir alafenamide. No vertical HIV transmission was detected (one infant still breastfed). The median milk/plasma ratios were 0.96/0.39 for raltegravir once/twice daily, 0.01 for bictegravir, 1.08 for rilpivirine, 0.12 for darunavir/ritonavir and 4.09 for tenofovir alafenamide. The median estimated infant daily dose (mg/kg) from breastfeeding was 0.02/0.25 for raltegravir once/twice daily, 0.01 for bictegravir, 0.02 for rilpivirine, 0.05 for darunavir/ritonavir and 0.007 for tenofovir alafenamide, resulting in relative infant dose <10% exposure index for all ARVs. CONCLUSIONS: ARVs were transferred to a variable extent in breastmilk. Nevertheless, the estimated daily ARV dose from breastfeeding remained low. Differential ARV exposure was observed in breastfed infants with some ARVs being below/above their effective concentrations raising the concern of resistance development if HIV infection occurs. More data on this potential risk are warranted to better support breastfeeding.

Evidence-based optimisation of empirical antibiotic regimens in paediatric complicated appendicitis: a retrospective study of 94 patients.

BACKGROUND: Acute appendicitis is the most frequent surgical emergency in the paediatric population. Complicated appendicitis accounts for 30% of cases and is inextricably linked to postoperative infectious complications. A study at our institution showed that amoxicillin-clavulanate resistant Escherichia coli in complicated appendicitis was significantly linked to postoperative infectious complications. These findings led to a change in the empirical antibiotic protocol (amoxicillin-clavulanate changed to ceftriaxone + metronidazole as of 2017), intending to reduce postoperative infectious complications in complicated appendicitis in our institution. AIM OF THE STUDY: This study aimed to analyse the microbiology and resistance profiles of pathogens of complicated appendicitis at our institution since implementing the new antibiotic protocol and the postoperative infectious complications rate. METHODS: We designed a retrospective comparative cohort study. During the defined study period (01 January 2017 to 31 July 2020), medical records were analysed for cases of acute appendicitis, complicated appendicitis and postoperative infectious complications, retaining only those who fulfilled inclusion criteria. Postoperative outcomes, microbiology and antibiotic resistance of peritoneal swabs were analysed. RESULTS: During the study period, 95 patients presented with a complicated appendicitis, and 11 (12%) developed postoperative infectious complications. The most frequent pathogens found in complicated appendicitis were E. coli (66%), Streptococcus anginosus (45%), and Bacteroides fragilis (22%). Pseudomonas aeruginosa was present in 17% of complicated appendicitis. Pathogens involved in postoperative infectious complications mirrored the distribution found in complicated appendicitis without postoperative infectious complications. Antibiotic susceptibility analysis showed that 10 (15%) of E. coli strains were resistant to amoxicillin-clavulanate but sensitive to ceftriaxone + metronidazole, with only one strain responsible for causing a postoperative infectious complication. Six additional strains of E. coli (9%) were resistant to amoxicillin-clavulanate and our empirical antibiotic regimen but were not associated with an increase in postoperative infectious complications. Compared with our previous study, there was a decrease in postoperative infectious complications from 16% to 12%. Postoperative infectious complications caused by amoxicillin-clavulanate-resistant E. coli decreased from 28% to 9%. CONCLUSION: This retrospective study demonstrated a decrease in the rate of postoperative infectious complications due to amoxicillin-clavulanate-resistant E. coli in complicated appendicitis. These findings accentuate the need to implement evidence-based treatment protocols based on local microbiology profiles and resistance rates to optimise post-operative antibiotics in complicated appendicitis.

Acute abdominal emergency due to infectious enteritis: an observational study comparing Campylobacter spp. to other enteric pathogens in children.

BACKGROUND: Campylobacter spp. are a frequent cause of gastroenteritis, presenting in some patients as an acute abdominal emergency. Here we describe the distinctive clinical characteristics of these patients. METHODS: We designed a retrospective, single-centre, observational study. Children and adolescents under 18 years of age who had positive stool cultures for Campylobacter spp. during the period between June 1, 2008 and May 31, 2016 were identified from our database. Hospitalised patients with Campylobacter spp. were then matched for age and gender with patients hospitalised for gastroenteritis of other or unknown aetiology. Patients who had undergone abdominal radiographic investigation or had received a surgery consultation were included as "acute abdomen" (AA) cases. Demographics, clinical characteristics and management were compared between AA and non-AA cases. RESULTS: One hundred and forty-one patients with cultures positive for Campylobacter spp. were included in the analysis. Nineteen patients were identified as AA cases. Fewer of these had diarrhoea (14/19, 74% vs 117/121, 97%; p = 0.02) and more reported a lower sense of general wellbeing (8/18, 44% vs 8/108, 7%; p <0.001). Localised pain (9/18, 50% vs 20/115, 17%; p = 0.002) and abdominal tenderness (2/18, 11% vs 0/111; p = 0.02) were also more common among AA cases. Forty-four patients with Campylobacter spp. infections were hospitalised and matched with 44 patients with gastroenteritis of other or unknown aetiology. Campylobacter spp. infection (risk ratio 3.6, 95% CI 1.3-9.7; p = 0.01) was positively correlated with being seen by a surgeon and/or a prescription for radiological examination. CONCLUSIONS: We identified a subset of patients with Campylobacter spp. gastroenteritis who present as an acute abdominal emergency. The presentation of these patients was characterised mainly by the nature of the associated abdominal pain.

[Vaccination in adult patients: shingles vaccines and vaccination in case of anatomical or functional asplenia]. / Vaccination chez l'adulte: vaccins contre le zona et vaccination en cas d'asplénie anatomique ou fonctionnelle.

Shingles vaccination and pneumococcal vaccination of patients with celiac disease are among the most recent updates for the vaccination of vulnerable adults, in Switzerland. Shingles and especially post-herpes zoster pain remain an unresolved public health issue. The only vaccine available in Switzerland is very little administered because it is not reimbursed by health insurance companies. A second shingles vaccine is announced for 2022 and should help to reduce the burden of this disease. It has been known for many years that celiac disease is accompanied by hyposplenism in adults. The resulting increased risk of invasive pneumococcal infections justifies, since 2020, a recommendation for vaccination against these encapsulated bacteria.

La vaccination contre le zona et la vaccination contre les pneumocoques des patients souffrant de maladie cœliaque font partie des mises à jour les plus récentes pour la vaccination de l'adulte vulnérable, en Suisse. Le zona et surtout les douleurs postzostériennes restent un problème de santé publique non résolu. Le seul vaccin disponible en Suisse est très peu administré en raison de son non-remboursement par les caisses-maladie. Un deuxième vaccin contre le zona est annoncé pour 2022 et devrait contribuer à alléger le fardeau de cette maladie. On sait depuis de nombreuses années que la maladie cœliaque s'accompagne d'un hyposplénisme chez l'adulte. Le risque accru d'infections invasives à pneumocoques qui en découle justifie, depuis 2020, une recommandation de vaccination contre ces bactéries encapsulées.

[SARS-CoV-2 in children: epidemiology, clinical presentation and contagiosity]. / SARS-CoV-2 et enfants : épidémiologie, présentation clinique et contagiosité.

Children are under-represented in terms of the frequency and severity of COVID-19 disease. Although the proportion of children tested positive remains much lower than that of adults suggesting that they are less susceptible to SARS-CoV-2 infection, seroprevalence studies are contradictory in this regard. With respect to the role of children in transmission of the virus, no biological reason for reduced infectivity has been found. However, in the community, children rarely seem to be the vectors of this infection. With regard to adolescents, epidemiological data and their behavior similar to that of young adults suggest that they contribute to the spread of the virus more effectively than younger children.

Les enfants sont sous-représentés en termes de fréquence et de sévérité de la maladie Covid-19. Même si la proportion des enfants testés positifs reste bien inférieure à celle des adultes, suggérant qu'ils sont moins susceptibles à l'infection par le SARS-CoV-2, les études de séroprévalence sont contradictoires à ce sujet. En ce qui concerne le rôle des enfants dans la transmission du virus, aucune raison biologique expliquant une moindre contagiosité n'a pu être mise en évidence. Cependant, dans la communauté, les enfants ne semblent que rarement être les vecteurs de cette infection. En ce qui concerne les adolescents, les données épidémiologiques et leurs comportements similaires aux jeunes adultes laissent supposer qu'ils contribuent à la propagation du virus de manière plus efficace que les enfants plus jeunes.

Ensuring Sufficient Trough Plasma Concentrations for Broad-Spectrum Beta-Lactam Antibiotics in Children With Malignancies: Beware of Augmented Renal Clearance!

Introduction: Broad-spectrum beta-lactams are commonly prescribed for empirical or selective treatment of bacterial infections in children with malignancies. In the immunocompromised, appropriate concentration exposure is crucial to ensure antimicrobial efficacy. Augmented renal clearance (ARC) is increasingly recognized in this population, and raises concern for unmet concentration targets. We conducted a retrospective evaluation of meropenem and piperacillin exposure in our hospital's pediatric hematology-oncology patients. Materials and Methods: We compared trough levels of meropenem and piperacillin in a cohort of unselected pediatric hematology-oncology patients stratified based on their estimated renal function as decreased, normal or with ARC, and on their neutrophil count. Results: Thirty-two children provided a total of 51 meropenem and 76 piperacillin samples. On standard intermittent intravenous regimen, 67% of all trough plasma concentrations were below targeted concentrations. In neutropenic children with bacterial infection, all meropenem and 60% of piperacillin levels were below target. Nearly two-thirds of total samples came from children with ARC. In these patients, antimicrobial exposure was insufficient in 85% of cases (compared to 36% in the decreased or normal renal function groups), despite a dosage sometimes exceeding the maximum recommended daily dose. Under continuous infusion of piperacillin, only 8% of plasma levels were insufficient. Discussion: Intermittent administration of meropenem and piperacillin often fails to ensure sufficient concentration exposure in children treated for malignancies, even at maximal recommended daily dosage. This can in part be attributed to ARC. We recommend thorough assessment of renal function, resolute dosage adjustment, continuous infusion whenever possible and systematic therapeutic drug monitoring.

[MMR vaccination at UNIL and EPFL†: Lausanne medical students get involved]. / Vaccination ROR à l'UNIL et à l'EPFL†: les étudiant·e·s en médecine de Lausanne se mobilisent.

In recent years, several cases of measles have appeared on the campuses of the University of Lausanne (UNIL) and the Swiss Federal Institute of Technology in Lausanne (EPFL). In response to this, several medical students have mobilized in collaboration with various cantonal authorities in order to set up a free measles, mumps and rubella vaccination campaign on the UNIL/EPFL campuses, in 2019. This first edition was a success and will be repeated in the future. Such an approach having shown its feasibility, it could be applied to other public health issues. The involvement of medical students could thus be extremely valuable if a generalized vaccination against SARS-CoV-2 were to take place.

Durant ces dernières années, plusieurs cas de rougeole sont apparus sur les campus de l'Université de Lausanne (UNIL) et de l'École polytechnique fédérale de Lausanne (EPFL). En réponse à cela, plusieurs étudiant·e·s en médecine se sont mobilisé·e·s en collaboration avec diverses instances cantonales afin de mettre en place en 2019 une campagne de vaccination gratuite contre la rougeole, les oreillons et la rubéole sur les campus UNIL/EPFL. Cette première édition a été un succès et sera reconduite dans le futur. Une telle approche ayant montré sa faisabilité, elle pourrait être appliquée à d'autres enjeux de santé publique. L'implication des étudiant·e·s en médecine pourrait ainsi être extrêmement précieuse si une vaccination généralisée contre le virus SARS-CoV-2 devait avoir lieu.

[Breastfeeding for HIV-positive mothers in Switzerland : are we ready to discuss ?] / Allaitement des femmes vivant avec le VIH : sommes-nous prêts à ouvrir la discussion ?

Mother-to-child transmission (MTCT) is almost inexistent in Switzerland nowadays. This success has been achieved with systematic screening of HIV in pregnant women, provision of antiretroviral treatment (ART), elective cesarean-section (CS), neonatal antiretroviral prophylaxis (ARP) and avoidance of breastfeeding. Elective CS and neonatal ARP are no longer recommended when the viral load (VL) is suppressed. Recent studies have shown that the risk of HIV MTCT through breastfeeding is extremely rare if not zero when the mother is treated, has a suppressed VL and is correctly followed-up. It is time to be open to discuss the risks and benefits of breastfeeding with HIV-infected pregnant women and to enter in a shared decision-making process, as recommended by the new Swiss guidelines. Close monitoring is mandatory in case of breastfeeding.

La transmission verticale du VIH est presque inexistante en Suisse aujourd'hui. Ce succès a été obtenu grâce au dépistage systématique du VIH de la femme enceinte et aux traitements antirétroviraux, à la césarienne élective (CS), à la prophylaxie postexpositionnelle néonatale (PPEn) et à l'évitement de l'allaitement. La CS et la PPEn ne sont plus recommandées en cas de charge virale indétectable. Des études récentes ont montré que le risque de transmission du VIH par l'allaitement est extrêmement faible, voire nul, lorsque la mère est correctement traitée et suivie. Il est temps de peser les risques et les bénéfices de l'allaitement maternel avec les femmes enceintes infectées par le VIH dans un processus de décision partagée, comme le suggèrent les nouvelles recommandations suisses. En cas d'allaitement, un suivi étroit est incontournable.

Prevalence of tuberculosis in migrant children in Switzerland and relevance of current screening guidelines.

AIMS: Since 2016, Swiss guidelines recommend screening of all migrant children <5 years of age for tuberculosis (TB) and to screen older children only if they have risk factors for TB. Our goals were to describe the epidemiology of latent tuberculosis (LTBI) in migrant children at the Lausanne University Hospital, to identify determinants of LTBI and tuberculosis disease (TBD), and to evaluate the risk of a false-positive tuberculin skin test (TST) when using a positivity limit of 5 mm. METHODS: Newly arrived migrant children 0–18 years of age were prospectively enrolled from 31 August 2015 to 31 August 2017. Every migrant child was assessed for the risk of TB exposure and TBD and was administered a TST. A TB-spot test was performed in children ≥5 years of age when the TST was positive. Children with clinical and/or radiological signs of TBD were further investigated. Children ≥5 years of age with a positive TB-spot test and children <5 years of age with a positive TST, without clinico-radiological signs of TBD received a diagnosis of LTBI. A false-positive TST result was diagnosed in children ≥5 years of age when the TB-spot test was negative. Potential determinants of TB (LTBI and TBD) and of false-positive TSTs were identified. Student’s t-test or the Kruskal-Wallis test were used for continuous variables and the chi-square test or Fisher’s exact test for categorical variables. All variables with a p-value <0.05 were included in a multivariate logistic regression model. RESULTS: Two hundred and fifty-three patients were eligible for the study. The median age of the patients was 8.1 years (interquartile range [IQR] 4.5–12.8) and 104 (41%) were female. Twenty-four percent of the patients (62/253) came from a country with a moderate–high incidence of TBD (≥80 cases per 100,000 individuals). Twenty-eight patients (11%) had positive TSTs, and TB was confirmed in 17 (6.7%) of these patients (16 with LTBI and 1 with TBD). On multivariate analysis, moderate–high incidence of TBD in the country of origin (adjusted odds ratio [aOR] 18.8, 95% confidence interval [CI] 5.1–68.6; p <0.001), older age (aOR 1.1, 95% CI 1.0–1.3; p = 0.025), and contact with a TBD patient (aOR 8, 95% CI 1.8–36.2; p = 0.007) were associated with a diagnosis of TB. Among the 23 children over 5 years of age who had a positive TST with measurement available, a measure between 5–9 mm was more frequent in case of a false-positive TST (5/9, 56% vs 0/14, 0%, p = 0.002). BCG vaccination was the only predictor of a false-positive TST (p = 0.03). CONCLUSION: Screening migrant children ≥5 years of age for TB could confer a public health benefit even in the absence of other risk factors. The limit of TST positivity could be raised from ≥5 mm to ≥10 mm to decrease the rate of false-positive results. A national assessment of migrant children between the ages of 5 and 15 should be carried out to confirm our findings.

[Congenital Toxoplasmosis and CMV in Switzerland in 2019]. / Toxoplasmose et cytomégalovirus congénitaux en Suisse en 2019.

Epidemiological trends in congenital toxoplasmosis and CMV are extremely divergent. While there were only 39 cases of congenital toxoplasmosis in Switzerland between 1982 and 2015, there was an equivalent number of cases of congenital CMV, 38 in total, in 2017 alone. Serological screening for toxoplasmosis was logically abandoned in Switzerland in 2008. Regarding CMV, there is no recommendation for serological screening or neonatal screening in Switzerland, whereas early diagnosis can improve prognosis through the rapid initiation of antiviral treatment. The epidemiological data generated by sentinel surveillance of congenital CMV infections in Switzerland may or may not justify such a measure in our country in the future.

Les évolutions épidémiologiques de la toxoplasmose et du cytomégalovirus (CMV) congénitaux sont extrêmement divergentes. Alors qu'on a recensé seulement 39 cas de toxoplasmose congénitale en Suisse entre 1982 et 2015, on a comptabilisé un nombre équivalent de cas de CMV congénital, 38 au total, pendant la seule année 2017. Le dépistage sérologique de la toxoplasmose a été logiquement abandonné en Suisse à partir de 2008. En ce qui concerne le CMV, il n'existe pas de recommandation de dépistage néonatal en Suisse, alors qu'un diagnostic précoce peut améliorer le pronostic par l'instauration rapide d'un traitement antiviral. Les données épidémiologiques générées par la surveillance sentinelle des infections congénitales à CMV en Suisse devraient permettre de justifier ou non une telle mesure dans notre pays à l'avenir.